| NPI | 1649558149 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CO ACD.0000140) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 140) |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2014-01-28 |